D4 Healthcare Engineering Project Management by pOYowRkL


									         Healthcare Engineering Project Management


In order to successfully manage a project of any size or type the Project Manager
(PM) must simultaneously manage the four basic elements of project
    1. Scope: Project size, goals and requirements and the tasks required.
    2. Time: Individual tasks with time durations, dependencies, and critical path.
    3. Resources: People, equipment and materials.
    4. Budget: Costs and contingencies.

All four of these elements are interrelated and should follow a logical process.
Managing projects in a healthcare setting presents unique challenges as the PM
is often confronted with defining one of the elements, cost or time for example,
prior to defining the other three elements. It is critical to avoid this trap unless the
customer has a set budget to work with or a date certain for completion.

Project Planning (Initial Steps):
Following through on a defined and consistent process can provide the
organization a level of comfort that the project will precede smoothly. The
following example is one method that can be used.

Project Title:
Give the project a name that generally suits the description of the project. Try to
include the department(s) directly impacted.

Mission Statement or Project Description:
This will begin to define the project scope and clearly establish the goal. Make
this brief, one paragraph at most.

Departments Involved in Project Implementation:
This will begin to define the resources needed to complete the project tasks. The
Maintenance Department may not be the only organizational resource needed.
Information Systems support may be required to assess computer needs. This
can define low voltage wiring requirements. Biomedical engineering may need to
be on board to define nurse call applications. Any project that takes place within
the hospital, long term care or clinic setting must involve Infection Control. Create
a list of these partners and engage them as you begin to define the scope.
Successful PM’s know their limitations but know where to source the information
required ensuring a successful project outcome. It pays to be humble.
Schedule a meeting with these departments before delving too far into the
planning process. Provide the meeting participants with an agenda that have the
project title and mission statement at the top. This allows participants to enter the
meeting knowing the overall scope and goal and puts everyone on the same
page. Collect as much information from these partners as possible. Be sure to
include the key project participants from your department in the meeting. People
like to be included rather than surprised. This fosters empowerment and
ownership in the project. At the close of the meeting define the next steps and a
projected time for a follow up meeting, which should occur prior to project start
up. Following through with this part of the process will firmly establish you in a
leadership role for the project.

Departments Affected During or After Implementation:
Change can be stressful. People do not like to be relocated. They do not like
noise, dust, disruption, etc. Will their phone number change? Will the bathroom
be too far away? Where will I park my car? How long will it take to finish? When
can I move in? You cannot control people’s stress but if you have a good handle
on the project you can alleviate their stress level. Effective communication prior
to project startup will save time and money. Once again, people do not like
surprises, especially negative ones. As you go through the process of defining
the project scope begin to list out those departments that will be affected.
Typically these are the departments that are in your project title but can also
include adjacent departments that may be affected by noise or departments that
have close working relationships with the primarily affected department(s).Do not
forget to assess the impact to patients and visitors. You may need to erect signs
before and during the project. Once your scope is defined it will become clear
who is affected. Sometimes a memo or email stating what is happening and
when it is happening will suffice. Depending on the department, or the individuals
in the department, or the department manager, a brief meeting may be required.
Giving folks a heads up will establish a level of confidence in your ability to
manage the project.

Project Planning (The Four Basic Elements):

This is the most important step in the planning process and should be worked in
conjunction with time, resources and costs.

If the project is a remodel, a good place to start is with an existing and proposed
floor plan that includes all attributes: architectural, structural, and mechanical
(plumping, HVAC, fire protection), electrical, and low voltage. If the project area
is complicated, a separate floor plan for each discipline may be needed. This will
be useful if you need to put portions of the project out to bid.
If the project is an equipment change, you can just focus on the elements that
relate to that piece of equipment; plumbing, HVAC, electrical support for
example. Equipment size or foot print of the equipment needs to be considered.

As you comprehensively lay out the scope individual tasks will become clear.
Think of your project scope as a set of tasks. Some can be worked concurrently.
Some need to be completed before the start of another task. Ensure that the
relationship between tasks is outlined as this will help in determining the critical
path of the project, which subsequently defines the project duration. List the
tasks in the order of progression highlighting those that require completion of one
task before the start of another. Be sure to include planning, design and
regulatory compliance (building permits, state Licensure approval, inspections,
and closeout) among your tasks if necessary. These elements often take time
and require precise scheduling to prevent wasted or down time for a project.

Using the remodel as an example, avoid the temptation of getting too far ahead
in the scope planning process. Designing a new or remodeled space is an
iterative process that requires buy in from the department(s) affected. For big
projects this can take time. But for projects managed and coordinated entirely by
the facility’s Maintenance Department a condensed approach can be utilized:
     Conceptual design: Start with a simple bubble diagram or rough hand
        drawn floor plan showing where new rooms or walls will be located. Meet
        with the affected department(s) to ensure that you are proceeding down
        the correct path.
     Schematic Design & Design Development: Develop a floor plan showing
        the location of casework, sinks, equipment, etc., anything that is
        necessary for operations. Meet again with the affected department(s) and
        review the proposal. You may have to provide demonstrations of space
        relationship showing how large or small a particular room or space is. It is
        a difficult exercise for some to look at a two dimensional drawing and
        relate that to a three dimensional space. People will sometimes request
        things that make no sense, like putting an office in a space no larger than
        a closet. Do not offend them by stating that it will not work. Instead
        reference standard guidelines like Architect Institute of America (AIA)
        Guidelines or Americans with Disabilities Act (ADA) Guidelines letting
        them know that at least 30” clear space is required to get around a desk
        without running the risk of getting “hip checked,” for instance. Expect to
        rework your plan after the meeting. Think ahead and make sure it is as
        easy as possible to redo your floor plan. Finally, have the affected
        department manager(s) sign off on the plan.
     Construction Documents: These are the detailed plans required for
        pricing, bidding and construction.

Scope changes should be anticipated. As stated previously, some have difficulty
seeing how plans will translate to actual space. That stated, it is not uncommon
for the realization of how the new or remodeled space will work operationally until
the space is near completion. Sometimes obstacles come up that have not been
or cannot be anticipated. If you manage an older facility you may not know what
is inside the wall until the sheetrock is removed. That is why a cost contingency
must be applied to the budget. See the Budget discussion below.

After “How much will it cost?” “When can it be finished?” is the most popular
question posed to the PM. Assign durations to each task identified. If you are
measuring task time in hours then the project is likely too small for a
sophisticated project management exercise. It is best to measure task durations
in days or half days. Project Management software tools are available that will
map out the tasks with assigned durations and the relative order of each task to
determine the critical path tasks and overall project time. These software tools
can be expensive and take time to learn. If this tool is not available you have a
few low cost options.
     Using graph or engineering paper, map out the essential tasks in a linear
       fashion ensuring that certain tasks cannot start until one or some are
     You can do the same process utilizing an Excel spreadsheet. Establish
       the time line across the top of the form and list the tasks vertically in the
       general order of progression.

An example would be that drywall, tape and texture cannot start until electrical
wiring, low voltage wiring, and plumbing rough in are complete. Painting cannot
start until drywall, tape and texture is complete. Some tasks may be able to
progress concurrently like electrical and low voltage wiring, unless the work
space is too tight for separate contractors to work concurrently. Segments on
your worksheet from left to right should represent days. Each task should be
drawn linearly to such a length to represent the duration of the task. Upon
completion, you will find that some tasks may be capable of completion days
before a subsequent task can start. These extra days represent float time for that
task allowing the PM to either start later, finish earlier or take days off in the

Each task needs to have an assigned duration and a float time. Tasks with zero
float time represent critical path items. Delays in critical path tasks will delay the
start of every subsequent critical path task. This becomes a critical tool in
scheduling trades. Delays can often result is cost overruns. This is where your
cost contingency comes in to play, again.

The questions you need to answer as you identify the tasks required for the
project are:
      How many people will it take to accomplish the task?
      Can I do tasks with in-house personnel or do I need to outsource the task?
      Does my staff have the time available and the qualifications necessary to
       complete the task?
      What materials are needed to complete the task?
      What equipment is required to complete the task?
          o Are we purchasing a special piece of equipment that is driving the
          o Does that piece of equipment require special attributes for
              operation such as electrical, plumbing, a space modification, etc.?
          o Do I need to rent a piece of equipment to perform a task?

Resources are typically cost items. Use this element to develop a project cost
spreadsheet. Large facilities can typically take some tasks on with in-house
personnel. With most Montana hospitals classified as critical access, engineering
departments can often be too small to take on time consuming projects. Taking
on tasks in-house can be a significant cost saver. Be sure you have the time and
skills required for the task. Outsourcing work can be a time saver allowing you to
devote your energies to the big picture of the project and ensure quality control.

Outsourcing certain tasks may be self-evident. For instance, not every
engineering department has a licensed electrician on staff. Your project may
require mechanical engineering services. Consider professional services as a
task even though it is not part of the construction process as it represents a cost,
requires time, and precedes most other work. Whether you decide to take on a
task in-house or outsource, the time required to complete the task is the other
piece of critical information required. Under estimations of task durations can
wreak havoc on the schedule, especially for critical path tasks. It is acceptable to
add some float to a task if you determine that the task is complicated or your
confidence in the trade is low. Avoid starting multi-day tasks on Friday, unless
you plan on working the task through the weekend or the schedule is so tight that
it is absolutely necessary. Friday’s are the least productive day of the week.

It is important to maintain a consistent tracking system for project costs. Excel
spreadsheets are good tools for this application. The files are easy to edit, you
can highlight cost items that require specific attention, and you can use the file as
a reporting document for your manager. Although your Fiscal Department can
provide general ledger and detail trial balance reports for a specific project code,
it is highly recommend to maintain your own file. For that to work you must
handle all invoices. Have your Fiscal Department assign a special project code
for the job. This can be done for building projects in excess of $5,000. They are
called Construction in Progress, CIP, codes. At the conclusion of the project you
can reconcile your file against the detail trail balance report.
Remember the most important question;” how much will it cost?” Project success
is measured primarily by cost. Therefore, do not answer this question until you
have the tasks either bid out or accurately estimated. Sometimes you may find
yourself cornered, so to speak, into providing an estimate. If you are, be
conservative. Once a dollar figure is floated it can become the budget, one that is
communicated to the Board of Directors. Should that be the case and you reach
a point where it is apparent that the actual cost will exceed the estimate, you will
be forced in to the dreaded “value engineering” exercise.

For estimating construction and remodels you can apply a cost per square foot
factor. You may have performed a number of projects so this becomes intuitive.
Regardless, it helps to network. Contact your Montana Society of Healthcare
Engineering partners and ask what they are seeing. An internet search of
hospital construction cost per square foot yields some interesting results.
However, cost will vary by region. General conditions in Montana are higher than
some other areas. Some areas of the hospital are more expensive than others
for remodeling costs. Since your project will likely not be the entire facility, take
that in to account.

The last item on your budget spreadsheet is for contingency. Construction
contingency should be 5% minimum. For complicated projects with anticipated
unknown problems use 10%, or more. If you are using design services you may
want to apply a contingency to that as well. The design contingency is specifically
for change orders. The quantity of change orders is relative to the complexity and
duration of the project. Reimbursable expenses for design services (travel,
lodging, printing materials, etc.) need to be accounted.

Consider and carefully manage the following factors to ensure that you meet your
project budget:
    Stay on schedule. Time is money.
    Carefully monitor the scope throughout the course of the project. Minor
       scope changes that are not accounted, often called “scope creep,” add up
       to cost increases.
    Manage your trades well, whether they are in-house personnel or sub-
       contractors. Know their strengths and weaknesses.

Successful project management is a process that takes practice to master. This
presentation is a simple outline. Your process may vary to suit your style or the
specific project. The American Society of Healthcare Engineering, ASHE, is
offering a Healthcare Construction Project Management Program (HCPM) in
Nashville in October. This two day course cost $625 for ASHE members. Go to
ashe.org for details. Next spring there will be an ASHE Region 10 construction
seminar in Boise, Idaho, where members can learn more about healthcare
project management. Finally, take advantage of the networking opportunities
through MSHE. Chances are that the project you are about to take on has been
done before. Contact your MSHE colleagues. Sharing experiences and helping
each other out is part of our mission.

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